Wolfgang Nebelung1, Heinz Wuschech. 1. Department of Rheumatology and Arthroscopic Surgery, Marienkrankenhaus Duesseldorf-Kaiserswerth, Duesseldorf, Germany. nebelung@kmr-kliniken.de
Abstract
PURPOSE: The incidence and progression of osteoarthritis over a time period of 35 years following anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly determined. Our study examined this. TYPE OF STUDY: Retrospective cohort clinical study. METHODS: Following a central guideline, between March 1963 and December 1965, all 19 athletes in the Olympic program of former East Germany who sustained an ACL injury were treated without reconstruction. In a retrospective cohort study, the clinical results were evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000; 18 of the 19 patients were examined arthroscopically in 1985. RESULTS: All patients were able to return to sports after a period of 6 to 14 weeks. Ten years after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%). The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%); 20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%). In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had a grade 4 chondral lesion. Ten total knee replacements had to be performed until the end of the year 2000. CONCLUSIONS: We conclude that, despite the possibility of return to high-level activity with a definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis will occur and patients will have a high risk of becoming a candidate for further total joint replacement. LEVEL OF EVIDENCE: Level IV.
PURPOSE: The incidence and progression of osteoarthritis over a time period of 35 years following anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly determined. Our study examined this. TYPE OF STUDY: Retrospective cohort clinical study. METHODS: Following a central guideline, between March 1963 and December 1965, all 19 athletes in the Olympic program of former East Germany who sustained an ACL injury were treated without reconstruction. In a retrospective cohort study, the clinical results were evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000; 18 of the 19 patients were examined arthroscopically in 1985. RESULTS: All patients were able to return to sports after a period of 6 to 14 weeks. Ten years after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%). The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%); 20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%). In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had a grade 4 chondral lesion. Ten total knee replacements had to be performed until the end of the year 2000. CONCLUSIONS: We conclude that, despite the possibility of return to high-level activity with a definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis will occur and patients will have a high risk of becoming a candidate for further total joint replacement. LEVEL OF EVIDENCE: Level IV.
Authors: Guillaume Demey; Robert A Magnussen; Sébastien Lustig; Elvire Servien; Philippe Neyret Journal: Int Orthop Date: 2011-07-14 Impact factor: 3.075
Authors: M A Kessler; H Behrend; S Henz; G Stutz; A Rukavina; M S Kuster Journal: Knee Surg Sports Traumatol Arthrosc Date: 2008-05 Impact factor: 4.342